Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2019; 7(3): 291-299
Published online Feb 6, 2019. doi: 10.12998/wjcc.v7.i3.291
Influencing factors of postoperative early delayed gastric emptying after minimally invasive Ivor-Lewis esophagectomy
Lei Huang, Jian-Qiang Wu, Bing Han, Zhi Wen, Pei-Rui Chen, Xiao-Kang Sun, Xiang-Dong Guo, Chang-Ming Zhao
Lei Huang, Jian-Qiang Wu, Bing Han, Zhi Wen, Pei-Rui Chen, Xiao-Kang Sun, Xiang-Dong Guo, Chang-Ming Zhao, Department of Cardiothoracic Surgery, Deyang People's Hospital, Deyang 618000, Sichuang Province, China
Author contributions: Huang L, Wu JQ, Han B, Wen Z, Chen PR, and Sun XK designed the research; Huang L, Han B, Guo XD, and Zhao CM performed the research; Huang L and Wu JQ contributed new reagents/analytic tools; Wen Z, Sun XK, and Guo XD analyzed the data; and Huang L, Wu JQ, Han B, Wen Z, Chen PR, Sun XK, and Zhao CM wrote the paper.
Supported by Science and Technology Support Plan of Sichuan Deyang Technology Bureau, No. 2015SZ023.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Deyang People's Hospital.
Informed consent statement: All patients gave informed consent to this study.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian-Qiang Wu, MD, Doctor, Department of Cardiothoracic Surgery, Deyang People's Hospital, No. 173, Taishan North Road, Deyang 618000, Sichuan Province, China. drwjq01@deyang_hospital.edu.cn
Telephone: +86-13548257132
Received: November 19, 2018
Peer-review started: November 19, 2018
First decision: December 9, 2018
Revised: December 12, 2018
Accepted: December 14, 2018
Article in press: December 15, 2018
Published online: February 6, 2019
Abstract
BACKGROUND

The main clinical treatment for esophageal cancer is surgery. Since traditional open esophageal cancer resection has the disadvantages of large trauma, long recovery period, and high postoperative complication rate, its clinical application is gradually reduced. The current report of minimally invasive Ivor-Lewis esophagectomy (MIILE) is increasing. However, researchers found that patients with MIILE had a higher incidence of early delayed gastric emptying (DGE).

AIM

To investigate the influencing factors of postoperative early DGE after MIILE.

METHODS

A total of 156 patients diagnosed with esophageal cancer at Deyang People's Hospital were enrolled. According to the criteria of DGE, patients were assigned to a DGE group (n = 49) and a control group (n = 107). The differences between the DGE group and the control group were compared. Multivariate logistic regression analysis was used to further determine the influencing factors of postoperative early DGE. The receiver operating characteristic (ROC) curve was used to assess potential factors in predicting postoperative early DGE.

RESULTS

Age, intraoperative blood loss, chest drainage time, portion of anxiety score ≥ 45 points, analgesia pump use, postoperative to enteral nutrition interval, and postoperative fluid volume in the DGE group were higher than those in the control group. Perioperative albumin level in the DGE group was lower than that in the control group (P < 0.05). Age, anxiety score, perioperative albumin level, and postoperative fluid volume were independent factors influencing postoperative early DGE, and the differences were statistically significant (P < 0.05). The ROC curve analysis revealed that the area under the curve (AUC) for anxiety score was 0.720. The optimum cut-off value was 39, and the sensitivity and specificity were 80.37% and 65.31%, respectively. The AUC for postoperative fluid volume were 0.774. The optimal cut-off value was 1191.86 mL, and the sensitivity and specificity were 65.3% and 77.6%, respectively. The AUC for perioperative albumin level was 0.758. The optimum cut-off value was 26.75 g/L, and the sensitivity and specificity were 97.2% and 46.9%, respectively.

CONCLUSION

Advanced age, postoperative anxiety, perioperative albumin level, and postoperative fluid volume can increase the incidence of postoperative early DGE.

Keywords: Esophageal cancer, Delayed gastric emptying, Minimally invasive Ivor-Lewis esophagectomy, Influencing factors

Core tip: Esophageal cancer is one of the most common gastrointestinal cancers. Minimally invasive esophageal cancer resection has achieved good results in the early clinical application of esophageal cancer and some advanced esophageal cancer. However, studies have shown that patients with Ivor-Lewis type esophageal cancer resection have a higher incidence of early gastric emptying disorder. This study explored the factors that influence the early onset of delayed gastric emptying after minimally invasive Ivor-Lewis esophageal cancer resection. The results show that advanced age, postoperative anxiety, perioperative hypoalbuminemia, and postoperative hyper-remediation can increase postoperative gastric emptying disorder. The incidence of obstacles affects the quality of life after surgery.